The Role of Donation After Circulatory Death in Heart Retransplantation: A United Organ Network for Organ Sharing Database Analysis

There are limited data regarding heart retransplantation (re-HT) using donors after circulatory death (DCD). We analyzed outcomes of adult re-HT using the United Network for Organ Sharing (UNOS) registry. We identified 630 adult recipients who underwent isolated re-HT or re-HT with simultaneous kidney transplantation between 2018 and 2024. Recipient and donor characteristics, as well as clinical outcomes, were compared between brain death (DBD) (n = 578) and DCD (n = 52) groups. The proportion of re-HTs using DCD donors increased from 1.9% in 2020 to 24.1% in 2024 (95% confidence interval [CI], 48.2-110.9; p = 0.013). Before matching, the DBD group had a higher acuity of illness, with a significantly greater proportion listed as UNOS statuses 1-2 (57.0% vs. 15.0%; p < 0.001). After matching, the DCD group had significantly longer ischemic time (3.3 [2.6-3.9] vs. 4.0 [3.0-5.9] hours; p < 0.001), and a higher incidence of early post-transplant graft dysfunction at 24 hours (1.0% vs. 5.9%; p < 0.001). However, rates of acute rejection before discharge (19% vs. 14%, p = 0.63) and 180 day survival (95.0% [90.9-99.4] vs. 88.0% [79.4-97.5], p = 0.12) were comparable between groups. The use of DCD donors in re-HT has grown significantly and shows similar early outcomes to DBD donors. Our findings support the clinical utility of DCD for re-HT.